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Optimizing Pancreas Transplant Allocation for Improved Outcomes

Proposal aims to expand pancreas transplant opportunities by revising blood type restrictions to maximize compatibility, potentially increasing transplants and reducing discards. It provides detailed changes and benefits supported by evidence.

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Optimizing Pancreas Transplant Allocation for Improved Outcomes

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  1. Broadened Allocation of Pancreas Transplants Across Compatible ABO Blood Types Pancreas Transplantation Committee

  2. What problem will the proposal solve? • Pancreas transplants have declined significantly since early 2000s • Current blood type restrictions prevent compatible transplants from occurring • These restrictions could lead to pancreata being discarded and fewer transplants

  3. What are the proposed solutions? • Prioritize high-cPRA ABO-identical candidates, then high-cPRA compatible candidates, then all identical, then all compatible • Allow A, non-A1 and AB, non-A1B compatible pancreas or kidney-pancreas to B candidates • Allow B pancreas or kidney-pancreas to B or AB candidates • Remove restrictions on blood type O compatibility: • A, B or AB candidates need zero antigen mismatch (0-ABDR) + cPRA ≥80 to receive O pancreas or kidney-pancreas in current policy

  4. Current KP Policy/Programming

  5. Current KP Programming

  6. Current vs. Proposed Allocation System

  7. Supporting Evidence

  8. Supporting Evidence

  9. Supporting Evidence The SRTR-modeled option chosen by the Committee shows: • Projected increase of 143 kidney-pancreas transplants • More kidney-pancreas transplants can reduce pancreas discards • The greatest difference in kidney-pancreas versus kidney-alone transplants: KP = +143 KIA = - 105 Difference = +38 • Projected net increase in transplants (+38) • Transplant Benefit • Greatest increase in Median Years of Benefit: 249 • Greatest increase in Life Years Following Transplant (LYFT): 240

  10. How will members implement this proposal? • Only one element of proposed changes require member implementation: • For A, non-A1 and AB, non-A1B to B KP or PTA compatibility transplant programs must do the same as they do kidneys • Obtain written, informed consent from B candidate • Establish a written protocol for A, non-A1 and AB, non-A1B to B titer thresholds • Confirm A, non-A1 and AB, non-A1B compatibility for B candidates every 90 days (+/- 20 days) • NOTE: Marking candidates eligible for A, non-A1 and AB, non-A1B kidneys makes them eligible for A, non-A1 and AB, non-A1B kidney-pancreas and pancreas

  11. Specific Feedback Titer thresholds for A, non-A1 and AB, non-A1B kidney-pancreas and pancreas-alone to B candidates: • Same as kidney, or different?

  12. How will the OPTN implement this proposal? • Anticipated Board Review date: December 3-5, 2017 • Programming in UNetSM • Changes to the match system • Evaluation for compliance: • Site surveys: review documentation for written, informed consent • Site surveys: verify that the program has a written protocol regarding titer thresholds • Post-Implementation Evaluation: • # of SPK transplants by blood type • Post-transplant survival and waitlist outcomes of SPK and kidney alone candidates and recipients pre/post implementation • Median time to transplant for SPK and KI by blood type

  13. Questions? Jon Odorico, MD Pancreas Transplantation Committee Chair jon@surgery.wisc.edu Abigail Fox, MPA Pancreas Transplantation Committee Liaison Abigail.fox@unos.org

  14. Extra Slides

  15. Impact on Blood Type O

  16. Minority Outcomes • KP

  17. Proposed KP Policy

  18. KPSAM Simulations • All compatible blood types allowed (R2) • All compatible blood types allowed and ABO identical candidates are prioritized. (R3) • High-cPRA ABO identical candidates prioritized, followed by ABO compatible candidates with high CPRA, identical candidates with low cPRA, compatible candidates with low cPRA (R4) • ABO-identical candidates prioritized above ABO-compatible candidates according to geographical stratification (local, regional and national classifications) (R5) • ABO-identical candidates receive offers through the national level, then ABO-compatible candidates offers through the national level (R6)

  19. Waitlist Mortality by ABO

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